| Objectives Hepatocellular carcinoma(HCC)is one of the most common malignant tumors.Although there are many treatment methods for liver cancer,the high recurrence rate,high metastasis rate and low survival rate in the treatment of liver cancer are still inevitable problems.Therefore,it is necessary to find effective prognostic indicators to evaluate and improve the prognosis of patients.The clinical value of prognostic nutrition index(PNI)in HCC has been reflected in previous studies,but its results are still controversial.Meta-analysis was used to quantitatively analyze all domestic and foreign studies on the correlation between prognostic nutritional index(PNI)and prognosis of hepatocellular carcinoma,and to explore the factors that may lead to heterogeneity among studies,in order to clarify the relationship between PNI and prognosis of HCC and better guide clinical decision-making.Methods Chinese databases such as CNKI,Wanfang,VIP,Chinese biomedical literature database and foreign databases such as Pub Med,Embas,the Cochrane Library and web of science were searched by computer,and all Chinese and English literatures on the correlation between prognostic nutritional index and prognosis of hepatocellular carcinoma published from the establishment of major databases to October 2021 were collected.After evaluating the literature quality of all included literatures and extracting effective data,meta analysis was carried out by Revman 5.3 software.I~2was used to judge the heterogeneity between studies;Subgroup analysis was used to explore the source of heterogeneity;The stability of the results was evaluated by sensitivity analysis;The hazard ratio(HR),odds ratio(OR)and corresponding 95%confidence interval(CI)were extracted to evaluate the relationship between PNI and the survival rate and clinicopathological features of hepatocellular carcinoma;Funnel analysis was used to evaluate the publication bias.Results Finally,26 literatures meeting the inclusion criteria were included.Among the8459 patients,7223 cases received surgery,719 cases received ablation and 517 cases received TACE.Meta analysis showed that low pre-treatment PNI was a significant predictor of poor OS(HR=1.64,95%CI:1.51-1.78,P<0.001)and DFS(HR=1.50,95%CI:1.32-1.70,P<0.001);At the same time,the significant correlation between low-level pre-treatment PNI and short-term long-term survival remained unchanged in subgroup analysis according to treatment methods,sample size and geographical region;In addition,PNI was significantly correlated with early postoperative tumor recurrence(HR=0.35,95%CI:0.25-0.47,P<0.001),postoperative complications(HR=0.23,95%CI:0.17-0.29,P<0.0001),liver cirrhosis(HR=0.59,95%CI:0.49-0.71,P<0.001),tumor size(HR=0.77,95%CI:0.63-0.95,P<0.05)and TNM stage(HR=0.50,95%CI:0.38-0.66,P<0.001);However,PNI was not significantly associated with serum AFP level(HR=0.98,95%CI:0.75-1.28,P>0.05),tumor number(HR=0.84,95%CI:0.69-1.02,P>0.05)or microvascular invasion(HR=0.71,95%CI:0.39-1.29,P>0.05)in patients with HCC.Conclusions Low level PNI before treatment is a poor prognostic factor for OS and DFS in HCC patients.Low PNI is associated with worse clinicopathological features such as liver cirrhosis,large tumor diameter and late TNM stage.At the same time,it is also a high-risk factor for early tumor recurrence and complications after liver cancer surgery.Therefore,it is not conducive to the long-term survival of patients.Figure 13;Table 3;Reference 182... |
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